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HomeMy WebLinkAbout040-1308-00-146 . CCOIX Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: .St Safety and Building Division INSPECTION REPORT Sanitary Permit No: 582008 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holders Name: City Village Township Parcel Tax No: Tribella Properties, LLC TOWN OF TROY 040-1308-00-146 CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No: D[~ N o 219 y-,,,L,*- 24.28.20.1965 TANK INFORMATION ELEVA ION DATA TYPE MANUFACTURER 3~,5 CAPACITY STATION BS HI FS ELEV. Septic 2n io ! 1ZSI~ Benchmark 7L j64.7Z. /ae ~g'r7P.l~ %1 J yls! -0 Fr l1..- Li P. I a k- SZ 5 Alt. BM Alv 63 y.72- /6 C, Aeration Bldg. Sewer /d S7 9//. / 5 qg` •i3 Holding SUHt Inlet jj q7 q4.3 , Z 5 qQy 'Z~ St/Ht outlet j I.93 9Z • "75 -1? TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Ven o Air Intake ROAD Dt Inlet Septic 13 / A) 17,u r _ Dt Bottom 10` Dosing Header/Man. EZ, y Z • %7 494 . Aeration Dist. Pipe C), Z., ~i qZ Bot. System ) 7 Z r k Holding Final Grade d5 ,ZZ 161-L PUMP/SIPHON INFORMATION Manufacturer Demand St Cover / )61.9$ GPM Lnl Jtli 7z .6 0 Model Number TDH Lift Fron Loss System Head TDH Ft Forcemain Len Dist. to Well SOIL ABSORPTION SYSTEM BED/TRENCH PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth Width / Length ( No. Of Trenches DIMENSIONS 3 Cl Q Z j gyp SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM CHLEACHING AMBER OR Manufacturer: ~ ~ INFORMATION Type Of Syste~] ! Z/ ^ y~ //tom UNIT Model Number: ~ 6--4' y Coot ~~py►. 'v /l/P~- f ~ S DISTRIBUTION SYSTEM Wco4-- z2 4-- -Z z s yt Header/Manifold Distribution ix Hole Size x Hole Spacing Vey to Air nta 1 ,j Pipe(s) ~ LDia 7 Length Dia Spacing COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only 77;:es Depth Over / Depth Over xx Depth of T Seeded/Sodded Bed/Trench Center S ZZ,, Bed/Trench Edges ` Topsoil ~xes 0 No 7 o e4 ✓w- d ot e.A e, r' Inspection #2: COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Location: 300 LINDSAY RD J~h~p~e" CO tJ~il. d e.. ~ 1.) Alt BM Description = 2.) Bldg sewer length = 23 r!,'k, Hoa' eL~j geo~ St - amount of cover = (1 U ✓ 5 0 Plan revision Required? FRI Yes 14 No 3a g b Use other side for additional information. Date Insepctors S' nature Cert. No. SBD-6710 (R.3/97) a., M y ro - r~ v r C~k ' ~ Sao I i ~jp o~ , , am on ~o xanrr 7_7 7~ County / Industry Services Divisi - f © S hh 1400 E Washington A San' Permit Number to be filled in b Co. Ps P.O. Box 7162 ( by ) A"4j~estot+"ST. CFZC? s'a(. O(,►'NY"•~' Madison, WI 53707- NITY Sanitary Permit Application Sate Transaction Number In accordance with SPS 383.21(2), Wis. Adm. Code, submission of this form to the appropriate governmental unit N■ is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS are submitted to the Department of Safety and Professional Services. Personal information you provide may be used for secondary Project Address (if different than mailing address) purposes in accordance with the Privacy Law, s. 15.04(1)(m), Stats. 1. Application Information - Please Print All Informatio Property Owner's Name Parcel # Property Owner's Mailing Address Property Location r~ ' I ag a 1 Q of Y Govt. Lot City, St e Zip Code Phone Number '/4,J X '/4, Section (circle o ) t~ N R /I/ E or(V II. Type of Building (check all that apply) Lot # ® 1 or 2 Family Dwelling - Number of Bedrooms Subdivision Name ❑ Public/Commercial -Describe Use Blo Z&W ❑ State Owned - Describe Use ❑ City of CSM Number El Village of 71 k.J. Zz CL ( ® Town of ~Q III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A. JZ New System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner IV. Type of POWTS S stem/Component/Device: (Check all that apply) 1171 Non-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade ❑ Mound > 24 in. of suitable soil hali ❑ Mound < 24 in. of suitable soil L.J o tng er Dispersal Component (explain) ❑ Pretreatment Device (explain) V. Dis ersal/Treatme Area Information: r Design Flow (gpd) Design Soil Application Dispersal Area Required (sf) Dispersal Area Proposed ( System Elevation 1 _9 / Rate(gpdso to ~7 I. Tank Info Capacity in V c Gallons Total # of PEJ16k nufacturer U E 5 - New Tanks Existing Tanks Gallons Units SZ a U = ~ n On NJ / J Septic or Holding Tank ❑ ❑ ❑ ❑ Dosing Chamber ❑ ❑ ❑ ❑ ❑ VII. Resp sibility Statement- I, the undersigned, assume respo ili or installation of the POWTS shown on the attached plans. Plumb ame rint) , Plumber's i r MP/MPRS Number Business Phone Number Plumber's Address (Street, City, S te, Zip Code 14 Ar A Y 17 VIII. n /De artment Use Only Approved ❑ pprove Permit Fete Date sued ,J t Issuin ent natur Owne n Reason for $ A4?5 • /6)/,3 IX. Condi TIED Vi0+p Reasons for Disapproval 71 Q J~ l ' ' I 1. Septic tank, efpuent fNter'tiln JJ dispersal cell moat all t ftJ~1'a('cue{-~td/\ hCw ~O,MQ. aa.JKGT. as per, management plan provided Oy plum4w- Z AA k mil ,wlgwall Attach to complete plans for the system and submit to the County only on paper not less than 8 12 x 11 inches in size SBD-6398 (R03/14) - i 00 _ - - CONVENTIONAL COMPONENT DESIGN Residential application INDEX AND TITLE PAGE i Project / Name: Owner's Name: L' Owner s Address: z1a :fit . m Legal Description: ,'44) 1y ~11 / - - 9«/ Subdivision: Y444/ Lot # Town: County: Parcel ID# Designer/Plumber: License #,-_-22z'~g Signature: - Date: ,/z,~ - 9-,1, Comments Designed pursuant to the In-Ground Soil Absorption Component Manual for POWTS Version 2.0 Index+Title 2/2/2012 w lJ f r r E0 00 I i i k : : I \ I I - J. Fund cads st' SdwdW&40 PVC Vent Pipe o S Wait Vent cap Leaching Chamber Sys wadon Soil tbor~+con Sys€ -M MR V 90 ft ft . Leaching Trench 9 ft Vent Or obswvafiOn Pip bem Lea ' 4° Di Trench 2 Header Chonber ©W - Manufacturer And Model EISA Rafing-,2 s4 It Per member Soli Application Rate QWsA it _ gpd Design Plow = ~ Sod App ion Rabe EISA = chambers 2 cows of chambers each. Page 3- of ~O J s ' ~ ~ PL 2- I T INSTALLATION IITS UClIONIs of :.s.^". - g'`': 'D.s~ r - iu S ,y j ZSui ^i',S••t5±.7~1.~i1tlc (A) tocats ouuet c tank I W JfVaa*e on to ftou etPipe. Okm (B) ReMvO tm* CGVeranct Pub (B) mak3 me vast of (B) koat 'gym #0 ifnecessely- is pied so thei tint be m" stus to Aror ,anti I fAII 't'Iat1IANG~ INSMUCtIONS . M •-hl• ~~S^'~'F+~,}ti. w3••-;~s~~' ` Nz ~ \ ~ ...3~•e- '}rr„ •-`3 a' ~ _ a - Vs s'• _ +yK•rTf~•1 f Y ~i'-g' is . v 1`3 5S° c- "IflU a 4A w~t ~ ~ +v t'~•tv'~+ r£.l.£a~^~..~,..,,_`'rs.;; __y.T . 4 • y. ~•-z~,.t•_' ~`.~F>;r1 - ..".pia . . j~e.., s:~~-.•- z• ~.i ¢ ~ ~ c r J • ~"s- ~7 stop 1: Dude of Me septic ~emk. (Step emove tank cow and pump ~#k c 2-- Stop 3: TdtCa 6 &a [T tt ( ktD #0 to ' y awma rg @ " : L = Y t€ t> fit 7 (B) pun " out Otto kanw. ~ is ~1 - ovalhasepwUnt pmoss Own MEN Make are A solis #d back WD to POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page S'of FILE INFORMATION SYSTEM SPECIFICATIONS Owner _ Septic Tank Capacity gal ❑ NA Permit # Septic Tank Manufacturer ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer ❑ NA Number of Bedrooms ❑ NA Effluent Filter Model ❑ NA Number of Public Facility Units ANA Pump Tank Capacity gal ~ NA Estimated flow (average) gal/day Pump Tank Manufacturer ANA Design flow (peak), (Estimated x 1.5) gal/day Pump Manufacturer NA Soil Application Rate gal/day/ftz Pump Model Xf NA Standard Influent/Effluent Quality Monthly average* Pretreatment Unit NA Fats, Oil & Grease (FOG) 530 mg/L ❑ Sand/Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BOD5) :5220 mg/L ❑ NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) :_150 mg/L ❑ Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ NA Biochemical Oxygen Demand (BOD5) :_30 mg/L Pd In-Ground (gravity) ❑ In-Ground (pressurized) Total Suspended Solids (TSS) 530 mg/L NA ❑ At-Grade ❑ Mound Fecal Coliform (geometric mean) :104 cfu/100ml ❑ Drip-Line ❑ Other: Maximum Effluent Particle Size Ys in dia. ❑ NA Other: ❑ NA Other: ❑ NA Other: ❑ NA *Values typical for domestic wastewater and septic tank effluent. Other: ❑ NA MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once every: ❑ month(s) (Maximum 3 ears) ❑ NA 1~ year(s) y Pump out contents of tank(s) When combined sludge and scum equals one-third (Y3) of tank volume ❑ NA Inspect dispersal cell(s) At least once every: ❑ month(s) (Maximum 3 ears) ❑ NA 0 year(s) y Clean effluent filter At least once every: ❑ month(s) ❑ NA 0 year(s) Inspect pump, pump controls & alarm At least once every: ❑ month(s) O NA ❑ year(s) Flush laterals and pressure test At least once every: ❑ month(s) ANA ❑ year(s) Other: ❑ month(s) At least once every: ❑ year(s) LM A Other: ❑ NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one-third (Y3) or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin Administrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, and any servicing at intervals of 512 months, shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. GMW (4/01) Page -1/0- of START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals that may impede the treatment process and/or damage the dispersal cell(s). If high concentrations are detected have the contents of the tank(s) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at-grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replacement system: A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. ❑ A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. ❑ The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed as a last resort to replace the failed POWTS. ❑ Mound and at-grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. < <WARNING> > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO NO ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTAL ER POWTS MAINTAINER LName Name Phone ne SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Name Phone Phone /S This document was drafted in compliance with chapter Comm 83.22(2)(b)0)(d)&(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code. Page f`~ of START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals that may impede the treatment process and/or damage the dispersal cell(s). If high concentrations are detected have the contents of the tank(s) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tan- may-fill above n- hiig-Kwater levees -Whe pn eriT-restortevd-the excess-wastewater-will-be - - - discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at-grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replacement system: fid A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. ❑ A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. ❑ The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed as a last resort to replace the failed POWTS. ❑ Mound and at-grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. < <WARNING> > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER Name _ l Name Phone / Phone -Wl- 7912 E SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Name Phone Phone /S This document was drafted in compliance with chapter Comm 83.22(2)(b)(1)(d)&(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code. ST. CROI X COUNTY SEPTIC TANTK MALhrTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM erfBuver J~,j 0am Mailing Address . Property= Address 4 t-\?erification required from Planning & Zoning Department for new co 'on.) Ci T/State`~''~ Parcel Identification Number 0o qa' ' d LEGAL DESCRIP'T'ION Property Location V" ; tj 2~< = Sec. T I~N R~W, Town of Subdivision Plat: V !t Lot # Certified Survey Map # , Volume , Page # Warranty Deed # (before 2007)Volume , Page # Spec house X yes 0 no Lot lines identifiable es 0 no SYSTEM MA iTENANCE A-N'D OWNER CERTIFICATION Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance responsibilities are specified in §SPS. 383.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 113 full of sludge. Uwe; the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth; herein, as set by the Department of Safety And Professional Services and the Department ofNatural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Planning & Zoning Department within 30 days of the three year expiration date. Uwe cerii + all --1 ments on this f a are true to the best of my/our knowledge. I/we am/are the owner(s) of the property, descn above, b}utue of a r deed recorded in Register of Deeds Office. Num r of be RE OF APPLICANT(S) DATE *Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed- (REV. 04112) N `!t doM UAW ~b OD 41 . 5z 2015 Property Record I St Croix County, WI Assessed values not finalized until after Board of Review Property information is valid as of OCT 05 2015 1024PM OWNER CO-OWNER(S) TRIBELLA PROPERTIES LLC PO BOX 210 HUDSON, WI 54016 FORMER OWNERS Q13 TROY DEVELOPMENT CORP PROPERTY INFORMATION Parcel ID: 040-130,6-00-146 PROPERTY DESCRIPTION Alternate ID: 24.28.20.1965 School Districts: SEC 19 T24N R19W PT NW NW ; BEING TROY VILLAGE 6TH (04) LOT 146 (1.004AC) SCH DIST RIVER FALLS Property Address: Other Districts: 300 LINDSAY RD CHIP VALLEY VOTECH Municipality: TOWN OF TROY Section Town Range Qtr %r $lion Qtr Section Block: DEED INFORMATION Plat Name: Volume Paae Document # TROY VILLAGE 6TH ADDN 146/168040-04 992020 Plat History: 992019 2015 TROY VILLAGE 6TH ADDN 146/168 040-04 09 100 753934 TAX INFORMATION LAND VALUATION Net Tax Before: 00 Valuation date: 20091109 Lottery Credit: 00 Code Acres Land Value ImgLgvements Total First Dollar Credit: .00 1.000 75,000 0 75,000 Net Tax After: .00 1.000 75,000 0 75,000 Amt. Due Amt. Paid Balance Tota[Acres. 1.004 Tax .00 00 .00 Assessment Ratio: .0000 Special Assmnt .00 .00 .00; Mill Rate: 0.000000000 Special Chrg .00 .00 .00 Fair Market Value: 000 Delinquent Chrg .00 .00 .00 Private Forest .00 .00 .00 Woodland Tax .00 .00 •00, INSTALLMENTS Managed Forest .00 .00 .00 Prop. Tax Interest .00 .00 P ri End Date Amount Spec. Tax Interest .00 .00 Prop. Tax Penalty .00 .00 Spec. Tax Penalty .00 .00 Other Charges .00 .00 _.00 TOTAL 00 00 .00 Over-Payment .00 PAYMENT HISTORY (POSTED PAYMENTS) General Special Date Receipt Source Type Amount Tax Status Assess Status Interest Penalty Total r Wlsmnsin Department of Commerce SOIL EVALUATION REPORT Page _ L of Division of Safety and Buildings in accordance with Comm 65. Wis. Adm. Code - n„ o~ Courtly ST. C.}Z01)C Attach complete site plan on paper not Jon include , but not limned to: verllcal end feronc~ end O (J percent slope, sc ale or dimenalans, nod Iota Petrel 1 D Q Barest d. Please prirmatl((o'1~ +n+. Date Panonar Information you provwa may ba uary "."UL. ."UL `Pr~ctJla~O.U Of (1) ( q. / t l r I Property owner ropsny tlon ST. CROIX CO NTY Zyr Z ZO( I COtJ~InlEI.1Tl. DE ~L~PMEM Co N F i°t tla 51ri t/4 S T -2 W Property Owner's Mailing Address o lock # Subd. Name or CSM# l 1X00 ft 6cD t~T. E gu1TE I oo l4(0 - -TRoy u, t_ IJAGE 6*k A 0 N City State p Code Phone Number. C3 My C3 Village 54 Town Nearest Road t_i!1 NE 55449 17L3 > 7-75(0$ OV 1 W1 5fY IZD• i New Construction User Residential I Number of bedrooms Lf Repiacoment _ Code derived design flow rate !o OQ _ GPO Public or convnercal - Describe: Parent material ~~cTu~RS++ 1 A t ± Sul A L Flood Flan elevation it applicable General comments - and recommendations: 0101QUT=-NT%Qk)A 31~-r~tROUND T12rcJJCtF1o5 0.7 t_OAotAW.. U Boring # ❑ Boring Pit around surface elev. ft. Depth to Ilmiting factor _ 90 in. _ Horizon Depth Dominant Color Radox Oescrfption Texture Structure Consistence Boundary Roots GPp n Rats in. MunseU Qu. Sz. Cont. Color Gr. Sz. Sh. 'Etf#1 'EfM2 0- 10 L - d 5 5 7- 4 3 !4- U-1 4 - ~ sl I 't z - o. 5 o,s Z--m dh its ztr 0.5 0-3 4 30 - vl~~l - s Jr -m 0.? , Z 4 -74 oYK - I s dl _ L _ 0.1 Lz i -90 wz-L1114 O•-7 Z ~ ~OKl `i v E 10°'l0 I-kOlt:.\ N 3 5 ® Boring N ❑ Boring r 5z Pit Ground aurh!ce elev. ry. Depth to IlmlNrtg factor 2 9(~? _ gin. 5a ~ 1 ~ Horizon Depth Dominant Col Redox Description Solt Application Race Texture Structure Consistence Boundary Roots GPD/tf i in. tdunseU Du. Sz. Cont Color i Gr. Sz. Sh. 'Etf#1 Eff#2 0- (OV.Cz/L L I . l 7- L l_ _ Lf Qi 3 v S S p i s V1C3/ 'tl L-f-mub dh c'S 2vf•m 0.5 0,$ 1-4-3 r 314 t 5 0 14 K,57/4 U cs r:0,-t z f V ra ( IliS 5 .4Jts lOcYo <.rC - 1za H _ clo Grc. Effluent #1 = BOD > 30 1720 mgrl and TSS >30 < ISO mg/L CST Name (Please Print) 'Effluent #2 BOD < 30 rng& and TSS < 30 rnglL ^ 1 Ignature ~J CST Number r JO Hot_l_ STE Address Address ZZ 119 32- Evaluation Conducted Telephone Number W987s b9o~``AVE, RIUE FAt1S wI stiozz y- 30-03 L-71 S y.Z6- X77,5 y. t Property Owner CO.VTIN ~NT~1_ QLr- Boring Boring I FiU i Parcel lD # PEND(N Page z of X47 ~ ❑ Pit Ground surface elev, q0 Z_ - tt. Depth to limiting factor Se_ in. Horizon Depth Dominant Color Redox Des Soil Application Rate cription Texture Structure Consistence Boundary Roots GPDAIF in. Munsell Ou. Sz. Cont. Color Gr. Sz. Sh. 'Eff#f 'Eff#2 1 _Lt I 1 L z _ cab -co 0,5 0. "1 f L - of-m o.5 3 1 3-zo 3 - s+1 Z alo dk a, ,S ,00-32- It K - I Zf d h 2 . ' ` dl D,~ ,Z 7 ~b8- o y Z -7 C tW S ? Hf u>d c ►oQto roK. 5 d l I - I - 0. A. Z Boring it~©onrig ~--,I ❑ pit Ground surface elev. ft. Depth to limiting factor _ in, Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots Soil ApGPD/fF plication Rate in. Munsell Cu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#t 'Eff#2 F7 Boring # ❑ Boring ❑ pit Ground surface elev. ft. Depth to limiting factor in. Soil ficaff Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/H` in• Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Efi#2 Effluent #1 = BODE > 30 < 220 mg/L and TSS >30 < 150 mg/L Effluent #2 = BODS < 30 mg/L and TSS < 30 mg/L The Department Of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. S00•1330 (R WW) 1 ~nG,.rr LEGENV: vo l N7 0 tS-f OF T A~ 49) - ~ - YR,o o u s I ~~`Xilt ~G~ItiG V'~/ 3PCKt10E VG COMM 83 `E?UPCK FFMEM5 l I jO0 LOT 146 - The site was graded after soil evaluations N+,cre completed (see page with final grade clev ations). System elevations Should not be affected. but depth below grade will need to be determined c0 based on the amount of cut or till. BM elccations Should have remained constant. B 14613 B 146A E ~V• 901.7 dELEV. 901.7 I~x i 00 1 \ ` I \ j B 147A ELEV. 901.89 ELEV. 02.1 / 1 I DO 9 l ELEVi:500.95 sruW-V csr zS; ZZ 4 ~ 3:4 FLOf PLAN PPC~~ y uaw. te- evil FiAIAL GRApG -1-~VHTiON 5 146 B 1468 B 146A ELEV. qoz.3 ELEV. Rc t. N s>o -`--902 B 147A 81478 ELEV. qOl. Z ELEV. 400,q -902- 1 CAIE• OJ -/g_ay